tbuckley/cabot-search huggingface dataset:
Abstract 11576: Association Between Pre-Operative Right Heart Catheterization Parameters and Outcomes in Isolated Coronary Artery Bypass Grafting
Authors: Irbaz Hameed, Andrea Amabile, Eric S Li, Doruk Yalcintepe, Ralf Martz Sulague, Victory B Effiom, Haleigh Larson, Arnar Geirsson, Matthew Williams
Journal: Circulation (2022)

Objective We evaluate the association between pre-operative right heart catheterization variables and outcomes in patients undergoing isolated coronary artery bypass grafting (CABG). Methods: All patients undergoing isolated CABG at our institution from 2013-2021 who also underwent pre-operative right heart catheterization &lt;14 days prior to isolated CABG were retrospectively queried. The primary outcome was operative mortality. Secondary outcomes were post-operative myocardial infarction, stroke, need for dialysis, duration of intensive care unit (ICU) stay, and duration of inotropic support. Results: Seventy-eight patients were analyzed. The incidence of operative mortality was 8(10.3%). The incidence of the secondary outcomes was 7(9.0%) for myocardial infarction, 5(6.4%) for stroke, and 4(5.1%) for need of dialysis. The median duration of ICU stay and inotropic support were 4[3.0, 7.8] and 2[1.3, 4.0] days respectively. On multivariable regression, central venous pressure was significantly associated with operative mortality (odds ratio (OR) 1.14, 95%CI 1.02-1.27, p=0.02) and duration of inotropic support (OR 1.02, 95%CI 1.00-1.03, p=0.04). Preoperative cardiac index was also significantly inversely associated with duration of ICU stay (OR 0.72, 95%CI 0.62-0.84, p&lt;0.001) and inotropic support (OR 0.76, 95%CI 0.63-0.92, p&lt;0.01). Conclusion Despite inclusion of cardiogenic shock in STS-PROM, baseline central venous pressure and cardiac index are independently associated with operative mortality, inotrope requirement and duration of ICU stay in patients undergoing isolated CABG. Assessment of pre-operative right heart function by right heart catheterization should be considered in this high-risk population to guide pre-operative optimization and intra-/post-operative decision-making.
Abstract 11306: Trajectories of Ticagrelor Adherence in Patients With Acute Coronary Syndromes
Authors: Jungyeon Moon, Aya Ozaki, Dennis T Ko, Alice Chong, Jiming Fang, Peter Austin, Maneesh Sud, Cynthia Jackevicius
Journal: Circulation (2022)

Introduction: Adherence is often measured using proportion of days covered (PDC), where the single average PDC that is estimated conceals the heterogeneity of the adherence patterns, each of which may require unique solutions. Novel group-based trajectory methods allow one to distinguish subgroups of adherence patterns. We examined the magnitude of variation in PDC estimates in these subgroups. Methods: We conducted a retrospective cohort study of patients aged ≥65 years who had filled ticagrelor within 7 days post-ACS discharge in Ontario, Canada between 4/2014-3/2018. Longitudinal patterns of adherence were measured using group-based trajectory models over 1 year and compared with traditional adherence metrics using PDC for the entire cohort and for each trajectory group. Results: We identified 9,764 ticagrelor users (mean age 73.6; 65.4% men). Three distinct trajectory patterns of ticagrelor adherence were identified: a consistently adherent, a gradually nonadherent, and a rapidly nonadherent group, comprising 67.8%, 17.1% and 15.1% of the cohort, respectively. The 1-year mean PDC (±SD) was 80.8±29.2 for the whole ticagrelor post-ACS cohort. After differentiating by adherence trajectory group, mean PDC (±SD) was 97.4±4.5 % in the consistently adherent, while it was 69.1±15.6% and 20.2±11.6 over 1 year in the gradually and rapidly non-adherent trajectory groups, respectively. Conclusions: The overall ticagrelor adherence of ~80% 1-year post-ACS instills a false sense of comfort. The 3 distinct trajectory groups revealed divergent patterns not reflected by this overall mean estimate. The two-thirds of patients who were consistently adherent maintained nearly perfect ticagrelor adherence, while the rapidly non-adherent group only took ticagrelor on average for 2.5 months of the year. The trajectory method approach allows us to distinguish adherence subgroups, and better identify patients at risk of nonadherence who need targeted interventions.
Abstract 11438: The Inflammatory Proteome, Obesity, and Medical Weight Loss in Humans
Authors: Andrew Perry, Kahraman Tanriverdi, Antonina Risitano, Shih-Jen Hwang, Venkatesh Murthy, Matthew G Nayor, SHilin Zhao, Daniel Levy, Ravi V Shah, Jane E Freedman
Journal: Circulation (2022)

Introduction: Most individuals regain weight after medical weight loss via “metabolic adaptation,” the mechanism of which remains unclear. Here, we studied the relation of circulating inflammatory proteins with weight loss and regain to identify a role for inflammation in metabolic adaptation. Methods: We analyzed 74 proteins related to inflammation and native immune regulation (Olink) in plasma from a maximum of 490 participants serially in a trial of medical weight loss maintenance. Linear and mixed effects regression models and t -tests were used to measure cross-sectional and longitudinal association of proteins with weight, with replication in the Framingham Heart Study (FHS). Results: Subjects included (60% women, 35% African American) had initial median weight of 94 kg, with a median loss 8 kg over 6 months of supervised medical weight loss, with subsequent median regain 2 kg over 30 months. We observed broad changes in inflammatory proteins with initial weight loss, many of which also tracked with weight regain (e.g. hepatocyte growth factor, interleukin-18, colony stimulating factor 1; Figure ). While many proteins have been implicated in weight regulation from mouse/human models, several are novel. Proteins associated with weight change involve pathways of angiogenesis, cell cycle regulation and immune response and are secreted from lung, adipose tissue, smooth muscle and others. Several proteins specifying chemotaxis and innate immune responses were associated with different rates of weight regain. Association with prevalent (but not incident) obesity was replicated for several proteins in the FHS. Conclusions: Broad changes in the inflammatory state track with weight (and its change during medical therapy) and may identify specific pathways that modify risk of weight regain. Further studies of innate immune activation in metabolic adaptation in humans to limit weight regain are warranted.
Abstract 11275: Comorbidity Score is Positively Associated With Hopelessness in Adults With Ischemic Heart Disease
Authors: Susan L Dunn, Nathan L Tintle, Melissa Gutierrez-Kapheim, Stephanie Eleanor Rivera, Windy W Alonso, Steven J KETEYIAN, Holli A Devon
Journal: Circulation (2022)

Introduction: Comorbidities are associated with increased risk of mortality in adults with ischemic heart disease (IHD). Hopelessness, a negative outlook and sense of helplessness towards the future, is identified in 27–52% of patients with IHD and associated with a 3.4 times increased risk of mortality or nonfatal myocardial infarction. The relationship between comorbidities and hopelessness in adults with IHD is unknown. Hypothesis: A higher comorbidity score is positively associated with state and trait hopelessness levels in adults hospitalized with an IHD event. Methods: Participants completed the State-Trait Hopelessness Scale and reported basic demographics. Continuous (range 0-14) and categorical scores for the Charlson Comorbidity Index (CCI) were generated based on patient medical records. Results: Participants (n=132) were typical of the U.S. IHD population except for race/ethnicity. Ninety-one were male (68.4%), mean age was 62.6 years (SD= 9.6), and 97% were non-Latinx White (3.0%). The mean CCI was 3.5 (SD=2.2), with 36.4% having a score of 1-2 (mild), 41.2% with a score of 3-4 (moderate) and 22.7% with a score of ≥5 (severe). The CCI was positively associated with both state and trait hopelessness in unadjusted and adjusted (demographics, medical history, and exercise history) analyses (unadjusted: r=0.26, p=0.002 (state); r=0.23, p=0.009 (trait) and adjusted: r=0.22, p=0.008 (state); r=0.18, p=0.052 (trait)). Components of the CCI showing the strongest relationships with higher levels of hopelessness were cerebrovascular accident (n=8), organ damage from diabetes (n=17), COPD (n=24), and renal failure (n=9). Interaction terms were evaluated and there was no evidence that the relationship between the CCI and hopelessness differed by age, gender, education level, or cardiac intervention type. Conclusions: Our hypothesis of a positive association between comorbidity score and state and trait hopelessness was confirmed. Knowledge of hopelessness in IHD patients with comorbidities is important for health care professionals in acute care and outpatient settings so at-risk patients can be identified and appropirate interventions employed. Future work should be conducted in larger, more heterogeneous samples.
Abstract 11610: Obesity and Metabolic Syndrome Among Heart Failure With Preserved Ejection Fraction Patients
Authors: Lee Kallenbach, Jay P Bae, David Nelson, Mac Bonafede, Kevin Lavelle, Karla Hurt, Masahiro Murakami
Journal: Circulation (2022)

Introduction: Recent data show a relative increase of HFpEF in heart failure. Additionally, an increase in prevalence of obesity and metabolic syndrome (MetS) in the population have been reported. Obesity and MetS differ across race, ethnicity, and sex. We sought to examine characteristics of patients with HFpEF by both obesity and MetS status to characterize differences in patient profiles for HFpEF. Methods: We examined data from the Practice Innovation and Clinical Excellence (PINNACLE) Registry® (American College of Cardiology and Veradigm) for HFpEF patients (LVEF ≥ 50%) and receiving care in a cardiologist clinic from 2016 thru 2019. Obesity is defined as BMI ≥ 30 kg/m 2 and MetS is approximated among patients with no history of myocardial infarction by presence of three of the four conditions (dyslipidemia, hypertension, obesity, and diabetes) at baseline. Results: Among 218,843 HFpEF patients, 56.7% had obesity, 50.4% had MetS, 34.8% had neither, and 41.8% had both. Obese patients were younger than non-obese (69.9 vs 74.9 years) and MetS patients were somewhat younger than non-MetS (71.7 vs 72.5 years). Over half of non-obese (62.7%) and non-MetS (53.8%) patients were 80+ years old. A higher proportion of women were obese than non-obese (57.8 vs 47.3%), while the proportion of women with and without MetS was similar (54.7 and 54.1%). Blacks have higher proportions of both obese and MetS than without (9.8 vs 5.2% and 9.6 vs 6.5%). Hispanics also have a higher proportion of MetS than without (4.9 vs 3.9%). MetS group exhibited a higher rate of all other cardiovascular comorbidities than the obesity group except for atrial fibrilation. Conclusions: In this large cohort of HFpEF patients in the ambulatory specialist care setting, nearly 2/3 of the HFpEF patients had obesity or MetS. MetS patients reflect an older more minority population with a higher proportion of comorbidities than obese patients.
Abstract 11115: Impella Preserves Systemic, Coronary, and Cerebral Blood Flows During Ventricular Fibrillation by Establishing the Acute Fontan Circulation
Authors: Shohei Yokota, Takaaki Maruhashi, Hiroki Matsushita, Midori Kakuuchi, Aimi Yokoi, Akitsugu Nishiura, Li meihua, Toru Kawada, Kazunori Uemura, Keita Saku
Journal: Circulation (2022)

Introduction: The ventricular fibrillation (VF) often occurs in acute heart failure patients with Impella support, percutaneous transvalvular left ventricular assist device. Although Impella can preserve blood pressure in some VF patients, the hemodynamic mechanism of Impella during VF remains unclear. Aim: In this study, we examined the impact of Impella on hemodynamics and cerebral and coronary blood flows in a goat model of VF. We also addressed the optimal blood volume status to maintain the Impella circulation during VF. Methods: In six goats, we inserted Impella CP via the left carotid artery. We simultaneously recorded right (RAP) and left atrial pressure (LAP), central blood pressure at ascending aorta (CBP), and the blood flows of pulmonary artery (PA), left coronary circumflex artery (LCX), and right carotid artery (CA). The VF was induced by direct current. We compared the impact of Impella support level (P0, P4 and P8) on hemodynamics and each blood flow. Under P8-Impella supported VF condition, we withdrew blood continuously and observed the left ventricular (LV) suction point at which a frequent negative LV pressure occurred. Results: As shown in Fig. 1 and 2, Impella maintained hemodynamics flow-dependently, indicating the establishment of acute Fontan circulation. In P8-Impella support, systemic (PA flow), LCX and CA blood flows were preserved by 50.1±27.7, 50.7±12.5 and 67.3±5.6%. from baseline, respectively. The blood volume reduction induced the suction of Impella (Fig. 3) at RAP below 9.9±1.9 mmHg. Conclusions: Impella establishes the acute Fontan circulation and preserves hemodynamics including coronary and cerebral blood flows during VF. The optimal blood volume status should be considered to maintain the Impella operation during VF.
Abstract 11650: Cardiometabolic Disease Protein Signatures and Response to GLP-1 Receptor Agonist in the EXSCEL Clinical Trial
Authors: Rachel Ostroff, Jennifer Green, Robert J Mentz, Jessica Chadwick, Michael Hinterberg, Natasha Kureshi, Missy Simpson, Stephen A Williams, Adrian F Hernandez, Rury Holman, Naveed Sattar, Svati H Shah
Journal: Circulation (2022)

Introduction: Recent type 2 diabetes (T2D) therapeutics have pleiotropic benefits. High throughput proteomic assays offer opportunities to systematically analyze T2D-related cardiometabolic traits and drug-related effects. Methods: The Exenatide Study of Cardiovascular Event Lowering (EXSCEL) trial randomized patients with T2D to once-weekly exenatide (EQW) versus placebo. This biomarker substudy of 5205 participants performed plasma proteomic profiling on baseline and 1-year samples using an aptamer-based platform. Changes in nine protein-imputed cardiometabolic traits were compared between treatment groups. In exploratory analyses, proteomic cardiovascular (CV) risk was stratified in individuals based on use of open label “drop-in” SGLT-2 inhibitors during follow-up. Results: Proteomic signatures for impaired glucose tolerance, body fat, and visceral fat decreased more in the EQW group compared with placebo (adjusted p&lt;0.05), partially consistent with EQW-induced weight loss ( Figure ). Protein-imputed resting energy rate, cardiorespiratory fitness, and lean body mass also decreased to a greater extent in the EQW group. Proteomic CV risk increased in both groups over one year but increased less in the EQW group (0.8% vs. 2.3%, adjusted p&lt;0.01). Individuals predicted at baseline to be at high CV risk had significantly lower observed CV event rates if they received “drop-in” SGLT-2 inhibitors (p&lt;0.05). Conclusion: Leveraging EXSCEL, a large-scale clinical trial of a GLP1-receptor agonist, this biomarker substudy uses proteomic signatures to demonstrate pleiotropic drug effects related to cardiometabolic traits. Further, proteomic CV risk increased to a lesser extent in individuals randomized to EQW, suggesting that EQW has beneficial effects influencing cardiovascular risk directly or indirectly through these proteomic pathways.
Abstract 11057: Glycosylation Profile of Immunoglobulin G and Incident Cardiovascular Events: Secondary Analysis of Two Randomized Clinical Trials
Authors: Rosangela Hoshi, Branimir Plava, Yanyan Liu, Irena Trbojevic-Akmacic, Robert J Glynn, Paul Ridker, Richard Cummings, Gordan Lauc, Olga Demler, Samia Mora
Journal: Circulation (2022)

Introduction: Alterations in the glycosylation pattern of immunoglobulin G (IgG) play a key role in the transition from healthy to diseased tissue, and have been related to inflammation, immune function, and cardiovascular disease (CVD) risk factors. Hypothesis: We hypothesized that IgG glycosylation patterns are associated with the risk of developing CVD events. Methods: IgG glycosylation profiles were measured using ultra-performance liquid chromatography on baseline plasma samples from two nested CVD case-control studies within the JUPITER (NCT00239681; Npairs=162; discovery) and the TNT (Npairs=367, validation) randomized trials. In both cohorts, we used conditional logistic regression adjusted for age, sex, statin, race, LDLC, smoking, hypertension, BMI, HDLC, triglycerides, and hs -CRP to examine the association of 24 IgG glycan peaks (IgG-GPs) with incident CVD events. In the controls sample, we performed Spearman correlation between IgG-GPs and hs -CRP, a biomarker of inflammation. Results: After adjusting for CVD risk factors and correcting for multiple testing (overall FDR&lt;.05), one agalactosylated fucosylated glycan (IgG-GP4) was positively associated with CVD risk (odds ratio [OR]=1.4, 95%CI= 1.1; 1.9), while three digalactosylated (IgG-GPs 12, 13, and 14), and one monosialylated glycan (IgG-GP 16) were negatively associated with CVD risk in JUPITER (OR ranging from 0.7 to 0.8, 95%CI=0.5; 1.0). The results replicated in TNT (Figure 1). IGG-GP4 positively correlated with hs -CRP, while an inverse non-significant correlation, was observed for IGG-GPs 12, 13, and 14 with hsCRP (Figure 1). Conclusions: Certain glycosylation traits were associated with risk of incident CVD independent of clinical risk factors and statin therapy. Specifically, one agalactosylated fucosylated glycan was positively associated with CVD risk, while digalactosylated and sialylated glycans were inversely associated with CVD risk in two independent cohorts.
Abstract 11580: Clinical Validation of a Smartphone Compatible 6L Electrocardiogram Device in Ambulatory Patients
Authors: Karlie Sample, Rylee Barber, Seabrook Whyte, David E Albert, Sunny S Po, Stavros Stavrakis
Journal: Circulation (2022)

Introduction: Novel ECG devices seek to facilitate easier obtainment of ECG recordings, while not compromising accuracy, compared to a standard clinical 12-L ECG. We aimed to compare the accuracy of the AliveCor Kardia 6L device with simultaneously recorded 12-L ECG recording with the patient in the same position. Hypothesis: The AliveCor Kardia 6L ECG device demonstrates data highly correlated with a standard 12-L ECG. Methods: We included patients seen in an outpatient cardiology clinic. ECG data using the Kardia 6L and a standard 12-L were obtained simultaneously in the seated position. Median beats for each method were compared using Pearson’s correlation. Results: One hundred patients (mean age 57±18, 55% female) were included. Lead aVL R wave amplitude (r= 0.99), T wave amplitude (r= 0.99), T wave axis (r= 0.96) QRS axis (r= 1.00), QRS duration (r= 0.94), and QT duration (r= 0.96) demonstrated excellent correlation between the two methods (Figure). Conclusion: The 6L Kardia device allows for accurate ECG measurements in ambulatory patients. This illustrates implications for the diagnosis of cardiac diseases, including left ventricular hypertrophy, in both clinical and nonclinical settings.
Abstract 11599: Risk of Bleeding With Concomitant Use of Oral Anticoagulants and Aspirin: A Systematic Review and Meta-Analysis
Authors: Daniel Malone, Priyanka Ghule, Jennifer Panic
Journal: Circulation (2022)

Introduction: Oral anticoagulants (OAC) (e.g., warfarin, rivaroxaban, dabigatran) and salicylates (e.g., aspirin) can trigger the occurrence of bleeding events when used alone or in combination. Objective: The objective of this study was to conduct a systematic review and meta-analysis to examine the risk of bleeding in individuals exposed to a combination of OAC and aspirin, compared to those taking OAC monotherapy. Methods: PubMed, EMBASE, Scopus, and Web of Science were queried in January 2021. Studies that described combined exposure to OAC and salicylates, had a control arm of monotherapy of OAC and reported the number of bleeding events in each arm were included. After studies were identified for potential inclusion, first, the title and abstract were screened, followed by a review of the full text. The following information was extracted from the included studies: citation, drug and dose of medication, the average age of participants, number of patients and bleeding events in each group, and population of interest. Pooled odds ratios were calculated using a random-effects model. Heterogeneity was evaluated with Cochran’s Q and I2 statistics. Results: A total of 509 studies were identified, of which 35 met the inclusion criteria for the meta-analysis. Studies were further categorized into two groups based on the design of the study (randomized control trial or observational studies). Out of 35 studies, 16 randomized control trials compared combined OAC and salicylates vs warfarin monotherapy and combination therapy was associated with an increased odds [OR: 1.37, (95% CI 1.17 to 1.61)] of bleeding compared to warfarin monotherapy. The second group consisted of 19 observational studies comparing combined OAC and salicylates vs warfarin monotherapy. The results suggested that combination therapy was associated with an increased odds [OR: 1.42, (95% CI 1.09 to 1.87)] of bleeding compared to aspirin monotherapy. Conclusion: Risk of bleeding is significantly increased among patients taking salicylates and OAC together as compared with those taking warfarin alone.
Abstract 11708: Giant Myxoma Causing Severe Pulmonary Hypertension
Authors: Hannah Bernstein, Hee Kong Fong, Surabhi Atreja
Journal: Circulation (2022)

Introduction: Myxomas are the most common primary cardiac tumor, with clinical manifestations depending on tumor size and location. We present a case of giant left atrial (LA) myxoma causing functional mitral stenosis and associated severe pulmonary hypertension. Case: A 75-year-old woman with newly diagnosed heart failure and atrial fibrillation presented to the emergency department with 2-months of chest pain and shortness of breath. She had left-sided chest pain during exertion and at rest, dyspnea, and 3-pillow orthopnea. She was normothermic, blood pressure of 93/57 mm Hg, HR 63 bpm, respiratory rate of 21, and 91% oxygen saturation on room air. Cardiovascular exam revealed no murmurs, elevated JVD and bilateral lower extremity edema. Chest CT revealed a large mass, measuring 9x4 cm, in the LA extending into the left ventricle. TTE demonstrated a large mobile mass in the LA measuring 9.4x3.9 cm. The mass extended through the mitral valve into the left ventricle, causing functional mitral stenosis with mean inflow gradient of 10 mmHg. Severe tricuspid regurgitation was demonstrated with a peak regurgitant velocity of 4.89 m/s, with estimated right ventricular systolic pressure of 101 mmHg. Pre-operative pulmonary artery systolic pressure was 100 mmHg. She underwent surgical excision. Histology confirmed diagnosis of myxoma, and the mass measured 7.2 x 5.0 x 4.7 cm. At follow up, she had no heart failure symptoms or additional episodes of atrial fibrillation. Repeat TTE demonstrated normal RVSP. Discussion: Symptoms of myxoma include cardiovascular, embolic and constitutional symptoms. While obstructive symptoms are common in large myxomas, only 10% have severe functional mitral stenosis. Despite this, sequela of pulmonary hypertension and tricuspid regurgitation is not well documented. Diagnosis is made by TTE, which also allows assessment of valvular and hemodynamic changes. Treatment requires surgical resection, with low rates of recurrence.